Firat Selvi

Intraosseous lipoma of the mandible: A case report and review of the literature

Intraosseous lipoma is a benign tumor of the bone. It is mostly seen in the metaphyses of the long bones and calcaneus. There are few documented cases of intraosseous lipomas in the jaw. Clinically, the lesion is usually silent and radiologically it appears as a radiolucent area rarely including some radio-opacities. Diagnosis is based on clinical, radiological and histopathological features. Surgical removal of the lesion is the recommended treatment. The authors report a rare case of an intraosseous mandibular lipoma in a 45-year-old female, and review previously documented cases in the English literature. The histopathological and radiological features of the lesion are emphasized.

Delayed Removal of a Maxillary Third Molar Accidentally Displaced Into the Infratemporal Fossa

The removal of an impacted maxillary third molar is an easy procedure for an oral and maxillofacial surgeon. The most commonly seen complications associated with this type of surgery are excessive hemorrhage, infection, pain, swelling, trismus, and root fractures. Although rarely encountered, unexpected complications may also arise during this procedure, such as the displacement of the tooth into an anatomic space. In this article, a case of a maxillary left third molar accidentally displaced into the infratemporal fossa is presented, and the delayed removal of the tooth after 3 weeks from the initial unsuccessful attempt is described, along with the correlating reasons. The role of the radiologic analysis in determining the localization of the tooth, including the routine panoramic radiographs and more importantly the volumetric computed tomographic scans, is stated. The different surgical treatment options are classified, and the potential for morbidity in the surgical removal of the tooth from the infratemporal fossa is presented by ranging the vital anatomic structures running through it.

Keratocystic odontogenic tumors: predictive factors of recurrence by Ki-67 and AgNOR labelling.

Purpose: The purpose of the present study was to investigate the possible role of Ki-67 and argyrophilic nucleolar organizing regions (AgNOR) between the recurrent and nonrecurrent keratocystic odontogenic tumors (KCOTs). Another aim was to compare the correlation between these two markers. Materials and Methods: 22 KCOTs were evaluated retrospectively. The actual proliferative activity of the KCOT was measured by Ki-67 labelling index and argyrophilic nucleolar organizing regions AgNOR count per nucleus. Results: Recurrence occurred in 3 patients (13.6%) during the follow-up period (mean follow-up, 37.8 months) The Ki-67 and AgNOR counts were significantly higher in the recurrent lesions comparing to the non-recurrent lesions. (p=0,045; p=0,049) The correlation between Ki-67 and AgNOR counts was found to be positive (r=0,853 p=0,0001). Conclusion: Within the limit of the present study, it is thought that Ki-67 and AgNOR might be helpful as a prognostic marker for the recurrences of KCOTs. These markers reinforced the meaning of the new classification of the lesion as an odontogenic tumor. Enucleation with curettage or decompression following enucleation with curettage is a simple and appropriate surgical model for the treatment of KCOT despite the relative high recurrence rate. On the other hand, the conservative treatment can be chosen only if there is no coronoid invasion, no interruptive cortical lysis and no tissular invasion.

Investigation of the risk factors associated with the survival rate of dental implants.

Purpose:The propose of this article was to evaluate the risk factors associated with the survival rate of the dental implants. Material and Methods:This retrospective study evaluated the survival rate of 940 implants placed at the Faculty of Dentistry, Department of Oral and Maxillofacial Surgery, Istanbul University, from January 2003 to January 2011. The potential risk factors associated with the survival rate of the implants were investigated. Results:Fifteen (1.5%) of the 940 implants failed during the follow-up period. Smoking did not affect the survival rate of the implants (log-rank, 1.5; P = 0.219). The survival rate of the implants placed in the maxilla was lower than that of the implants placed in the mandible (log-rank, 4.81; P = 0.028). The 5-year survival rate of the dental implants was 98.5%. Conclusions:There are still conflicting results about the risk factors associated with the survival rate of the implants. According to the results of this study, it is concluded that only the location of the implants is associated with the survival rates of the implants. All implant systems showed high survival rates.

Decompression, enucleation, and implant placement in the management of a large dentigerous cyst.

The dentigerous cyst is a developmental odontogenic cyst, accounting for 10% of all cysts of the jaws. The treatment options are decompression, marsupialization, or enucleation regarding the features of the lesions. In this article, a case of a 17-year-old adolescent girl having a large mandibular dentigerous cyst associated with an unerupted third molar is presented. The treatment is composed of decompression for 6 months and enucleation. Decompression and enucleation are a predictable choice in the treatment of large cysts. Radiologic evaluation is mandatory to decide for the appropriate time for the removal of the decompression stents, the enucleation time, and also for the evaluation of the adequate new bone formation for implant placement. The present case emphasizes the success of a conservative approach in the management of a large dentigerous cyst in a young patient and also the maintenance of the new bone formation without using any graft materials for the placement of dental implants.

Identifying dental panoramic radiograph features for the screening of low bone mass in postmenopausal women

A retrospective cohort study was performed to evaluate the use of panoramic radiographs as a screening tool for low bone mass in postmenopausal women. Female subjects aged ≥50 years were included. The predictor variables were gonial angle, antegonial angle, mandibular cortical bone integrity, periodontal disease status, and number of remaining teeth. The primary outcome variable was bone mineral density status. Descriptive and logistic regression statistics were computed; P<0.05 was considered significant. The sample was composed of 273 subjects, aged 50-89 years. Visual assessment of mandibular cortical bone integrity demonstrated a statistically significant correlation with low bone mass diagnosis on univariate logistic regression (P=0.019), but lost significance on multivariate analysis with age, body mass index, and number of remaining teeth (P=0.6). A visual estimation of the mandibular cortical bone integrity from panoramic radiographs may be useful for identifying postmenopausal women at high risk for osteoporosis.

Detection of the anaerobic bacteria in the odontogenic cyst fluids using polymerase chain reaction (PCR) method

Odontogenic cysts are slow growing lesions which are formed by epithelium. They may reach to a substantial size without symptoms for a long time. Radicular cysts’ (RCs) and odontogenic keratocysts’ (OKCs) are common odontogenic cysts of jaws. The main purpose of this study is to evaluate if anaerobic bacteria play a role in the pathogenesis of the RCs and OKCs fluids by polymerase chain reaction (PCR). Odontogenic cyst fluid samples with a history of infection were collected from a total of 28 odontogenic cysts consisting of 16 samples of OKCs and 12 samples of RCs. Anaerobic bacteria detection were performed by PCR based on bacterial 16S rRNA genes. Porphyromonas gingivalis existed more frequently compared to the other bacteria, in all samples (39.2%). Following this, F. nucleatum (32.1%), Provetella intermedia and Campylobacter rectus ( 25.5%), Treponema denticola (25%), Provetella nigrescens and Tannerella forsythia (17.8%), Dialister pneumosintes (14.2%), Filifactor alocis (10.7%), Porphyromonas endodontalis and Provetella pallens (7.1%) were seen. The 58.3% of the Fusobacterium nucleatum positive cyst fluids were in the RCs group. In D. pneumosintes positive cysts liquid samples, C. rectus was found to be positive (p=0.025). The same correlation was observed between F. alocis and C. rectus (p= 0.003). On the other hand, in F. alocis positive cysts liquid samples, F. nucleatum also was found to be positive (p=0.026). Odontogenic cysts fluid contained numerous anaerobic bacteria of various types, thus suggesting that oral bacteria may cause symptoms in odontogenic cyst fluids. Further studies are needed to assess the role of these bacteria in the pathogenesis of odontogenic cysts.

Complication of polymethylmethacrylate bone cement in the mandible.

Polymethylmethacrylate bone cements have been widely used in orthopedic surgery as well as in maxillofacial area. Despite the advantages, it is well known that acrylic bone cements may cause bone or soft tissue necrosis because of the properties of its components and polymerization. This clinical report presents an extensive necrosis of the mandible after the use of the acrylic bone cement to fill the cyst cavity. The purpose of this article was to alert the clinicians about the complications that may occur after the use of the polymethylmethacrylate-based bone cements.

Bisphosphonates and Bone

Bisphosphonates are pyrophosphate analogues which were used for over a century in industry (mainly in the textile and oil industries) as antiscaling and anticorrosive agents because of their property of inhibition of calcium carbonate precipitation. After the discovery of biological effects of bisphosphonates more than 30 years ago, they have now become indispensable in medicine for the treatment of skeletal complications of malignancy, Paget’s disease, osteoporosis, multiple myeloma, hypercalcemia and fibrous dysplasia.

Species and number of bacterium may alternate IL-1β levels in the odontogenic cyst fluid

Abstract Objectives The role of oral bacteria in the etiopathogenesis of odontogenic cysts (OC) is controversial. Immune response is regulated by the cytokines secreted during infection. This study aims to describe the association in between bacteria and levels of cytokines in OC. Methods Infected OC fluid samples were obtained from 25 odontogenic keratocysts and 14 radicular cysts (RC). Bacteria detection was performed by polymerase chain reaction on bacterial 16S rRNA genes. Cytokine levels in OC fluids were determined using “luminex” method. Results Porphyromonas gingivalis was the most common bacteria in all samples (41.03%). Bacteria species number was higher in RCs. The significant difference was detected in terms of interleukine (IL)-1β levels to the number of bacteria contained in cyst fluids (p<0.05). IL1-β level of cyst fluid group containing three or more species of bacteria increased compared with cyst fluid group containing two types of bacteria (p<0.05). IL-1β level was high in cyst fluids with Campylobacter rectus and Treponema denticola or with three or more bacteria species. IL-1β level was higher in the cyst fluids with Enterococcus faecalis negative than E. faecalis positives. Conclusions Our results suggest that species and the number of bacterium may differ IL-1β levels in the OC fluid.